Jugular bulb diverticulum

Ear, Nose & Throat Journal, March, 2007 by J. Walter Kutz, Jr., Antonio De la Cruz

A 5-year-old girl was referred for evaluation of a vascular mass behind the tight tympanic membrane (figure). The mass had been discovered incidentally by her pediatrician. She denied heating loss, tinnitus, or fullness, and audiometry revealed normal heating. Findings on high-resolution computed tomography (CT) were consistent with a jugular bulb diverticulum, and the family was reassured. At follow-up 12 years later, a repeat examination showed no change in the mass, and the patient continued to deny any symptoms.

A jugular bulb diverticulum is an upward extension of the jugular bulb into the middle ear. It is important to recognize this uncommon entity in order to avoid unnecessary investigation and surgery. CT can be a useful means of differentiating a jugular bulb anomaly from a vascular neoplasm; with a jugular bulb abnormality, CT will demonstrate dehiscent bone over the bulb, while most vascular neoplasms will demonstrate destructive changes. Significant bleeding after myringotomy or other trauma has been reported. In addition, conductive heating loss, pulsatile tinnitus, and fullness occur. Treatment consists of reassurance and observation.

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J. Walter Kutz, Jr., MD; Antonio De la Cruz, MD

From the House Ear Clinic, Los Angeles.